PNEUMOCYTOSIS
Pneumocystis is a type of pneumonia that is initiated by a fungus called pneumocystis jirovecii. It was initially classified as a protozoan disease but later re-categorized as a fungus in the year 1988. Initially, pneumocystis used to occur scarcely in patients ailing from acute lymphocytic leukaemia, individuals who were getting corticosteroid therapy or patients with suppressed immunity lacking proteins. Currently, pneumocystis disease is common in patients having human immunodeficiency virus. This fungus triggers pneumonia in people whose immune system is weak, such as patients living with HIV & AIDS, cancer and those under immune suppressive medication. There are limited remedy options for patients suffering from pneumocystis pneumonia. Pneumocystis carinii pneumonia (PCP) is now more common as a result of the rising rate of organ transplants and also the development of new immunotherapies. Research on pneumocystis is hindered by lack of a system for the continued propagation of the organism. The human version of pneumocystis is pneumocystis jirovecii while pneumocystis carinii is used to refer to the rat version.
Diagnosis and Laboratory workup
Due to the lack of precise signs and symptoms, it may be hard to diagnose pneumocystis. Also, the use of prophylactic medicine while treating AIDS and concurrent infections with many organisms makes it tough to diagnose the disease. The diagnosis involves conducting a microscopical test to detect pneumocystis from a clinically significant resource such as lung tissue since pneumocystis cannot be refined. A patient’s sample from the lungs is obtained, usually mucus and taken to the laboratory for examination using a microscope.
The first step in detecting pneumocystis in patients with HIV& AIDS is sputum induction with hypertonic saline. If the results turn out to be negative for pneumocystis, bronchoscopy with bronchoalveolar lavage should be carried out. Research has been done regarding the application of polymerase chain reaction (PCR) to identify pneumocystis nucleic acids. The results indicate that (PCR) is highly sensitive for the diagnosis of pneumocystis as compared to conventional staining when PCR primers for the genes pneumocystis mitochondrial large subunit ribosomal are used.
Transmission
The mode of transmission of pneumocystis is from one infected person to another through the air.Pneumocytosis carinii was captured through filtration of air in the vicinity of cages having rats that had been infected with pneumocystis. A nested polymerase chain reaction amplification of thymidylate synthase gene indicated that pneumocystis carinii DNA was present on the filters. This confirms that pneumocystis is transmitted through the air.
People may also acquire this disease through sources from the environment. Individuals who do not have the condition may be carriers hence spreading it to other people whose immune systems are weak.
Treatment of pneumocystis
Pneumocystis is treated using antipneumocystic drugs in combination with related steroids to prevent inflammation.Trimethoprim/sulfamethoxazole is the most frequent medicine used in treatment, although it causes allergy to some patients. Other drugs used include dapsone, primaquine, pentamidine, atovaquone, trimetrexate and pafuramidine. The healing phase is close to three weeks. However, pentamidine is rarely used because it has limitations such as leading to fever, the toxicity of the liver, kidney failure, pancreatic inflammation, rash and low blood sugar. Trimethoprim-sulfamethoxazole is the most effective medication for pneumocystis, although it does not favour patients who are sensitive to sulfa. Treatment for pneumotocysis for patients having AIDS and expectant mothers should commence when the CD4 count goes below 200 cells/millimetre or in cases where there is an existing account of or pharyngeal candidiasis. Trimethoprim-sulfamethoxazole is the best advisable medication for pneumocystis in patients who do not have HIV infection, and the recommended dose should be between 15 to 20 mg/kg orally in either 3 or 5 divided doses. Patients ailing from AIDS need three weeks of therapy for pneumocystis carinii pneumonia while other people need two weeks of medication. Patients who are admitted at the hospital ought to be subjected to intravenous treatment until they recover enough to be able to take in oral medicine.
A study was conducted involving 13 patients who have acute leukaemia, and the results indicated that sulfamethoxazole lowered the occurrence of PCP significantly by 85%.Trimethoprin may be given out three times a week or once on a daily basis. Studies previously conducted show that vaccinating animals with pneumonia carinii does not save them from pneumonia.
Some of the drugs for prophylaxis against pneumocystis pneumonia are; Trimethoprim-sulfamethoxazole. The dose is one reliable tablet orally taken three times in a week, being the most preferred medication. Another one is dapsone, and the recommended dose is 50mg orally taken twice on a daily basis or 100mg daily. However, the patient should not have glucose six phosphate dehydrogenase insufficiency.Pentamidine should be given on aerosol basis,300mg monthly basis.Atavaquone is another recommended drug that is administered orally, a dose of 1500mg on a daily basis. It should be given together with foods containing high-fat levels to ensure full absorption.
Etiologic Agents
It took so long to recognize and classify the organism behind pneumocystis disease fully, and the first discovery was made in the twentieth century by Carlos chagas.He used a model of guinea pig of trypanosome infection. Antonio carii succeeding identified it in lungs of a rat. Pneumocystis jirovecii is an organism that was identified in the lungs of tiny mammals, rodents and man. This parasite is common in the lungs of patients suffering from interstitial plasma cell pneumonia of young newborns. The organism is classified as a protozoan because it has characteristic features of protozoa while some writers categories it as fungus because it has a bigger genetic homology to fungi. The parasite has also been identified as present in adult lungs. Pneumocystis jirovee causes pneumocystis pneumonia with signs and symptoms such as fever and cough.Dr. John J.Ruffolo came up with a life cycle for pneumocystis fungi. The Asexual stage-trophic types conjugate to make a zygote. The zygote produced goes through meiosis and mitosis to form 8 haploid nuclei. Lastly, a trophic stage where organisms reproduce through binary fission Pneumocystis jirovecii leads to infections of the lung in immunosuppressed patients. This parasite is also found in children who are HIV positive with severe pneumonia. The organism is familiar with children and causes a death rate of fifty per cent. It is advisable to use pneumocystis jirovecii prophylaxis for babies below one year who are infected with HIV irrespective of their CD4+
Count, Children who have HIV with CD4+ counts under age-specific limit and children who are subjected to HIV as from the age of four to six weeks till the infection is invalidated.
Geographical Distribution and Epidemiology
Pneumocystis was rare until the emergence of HIV & AIDS. Later on, the disease became common among people who have AIDS after the condition came into existence.
Pneumocystis jirovecii is mostly found in infants as indicated by the rise in anti-pneumocystis antibody titers in their early age. A research carried out in Spanish showed that out of two hundred and thirty-three babies, the seroprevalence was seventy-three per cent. Also, seroprevalence relating to age rose from fifty-two per cent at the age of six to sixty-six per cent at the age of ten and eighty per cent at thirteen years.Pneumocytis is easily detected in young children, and it is associated with disorders such as bronchiolitis and death.
In research conducted on HIV patients, the prevalence differs depending on the particular population under study. In an analysis of HIV patients having pneumonia and have no pneumocystis carinii pneumonia (PCP), PCR analysis with sputum samples indicated that sixty-nine per cent had pneumocystis. Another report on autopsy lung tissue from men having AIDS dying from other causes apart from PCP showed that forty-six per cent of these people had pneumocystis.
Pneumocystis carinii pneumonia is spread worldwide. Pneumocystis has spread out in all continents apart from Antarctica. At the age of four years, seventy-five per cent of young ones are usually seropositive. This implies that there are higher levels of exposure to the disease. Pneumocystis disease is prevalent, and this was proved by research that was carried out in Chile. Ninety-six individuals who had passed away as a result of different causes such as accident, committing suicide, among others indicated that sixty-five of them had pneumocystis in their lungs. Pneumocystis carinii organism was discovered in the lungs of rabbits, mice, rats goats, sheep, horses, monkeys, ferrets, dogs guinea pigs and chimpanzee. According to reports,P canirii is present in minor human beings and animals worldwide. There was a report confirming that animals transmit this disease to their fellow animals.
Pathogenesis-Mechanism of damage, Host and Microbe factors involved in disease
The mode of entry for pneumocystis carinii has not been clearly confirmed, but since the parasite has been located in the lungs, therefore it is assumed that inhalation is the means of spreading. Animals confirmed cases of airborne transmission. Pneumocystis infects lung tissues, interstitial and leads to thickening of alveoli and alveolar septa hence leading to acute hypoxia. This hypoxia may be dangerous if it is not attended to on a severe level. Pneumocystis is usually present in patients with weak immunity; hence the primary infection in patients with HIV/AIDS.
The risk factors for pneumocystis in patients living with AIDS include; fever of more than 37.7 degrees Celsius for a period more than two weeks, a prior occurrence of pneumocystis carinii pneumonia, a record of oropharyngeal candidiasis and a CD4+ cell count of less than 200 per cubic mm. Risk factors include; smoking, environmental factors such as living in overcrowded areas such as prisons, toxins such as gasoline and old age. Weak airway protection, change in consciousness resulting from alcohol and chronic diseases such as asthma also forms part of the risk factors.
The host needs to have a proper inflammatory comeback to curb pneumocystis pneumonia. Inflammation leads to pulmonary injury at the time on the infection. Severe Pneumocystis pneumonia may lead to damaging of the alveolar, difficulty in breathing and breathing failure to the host.
Clinical form
Pneumocystis is common in patients living with AIDS, with a CD4+ count below two hundred cells. The signs and symptom of pneumocystis carinii pneumonia may be slight. The symptoms associated with PCP include cough, fever, dyspnea, lactate dehydrogenase. These symptoms grow slowly from weeks to months. Raw analysis indicates tachycardia, tachypnea and genetic findings on lung auscultation. Patients showing slight signs of pneumocystis pneumonia may be nursed as outpatients through oral treatment and constant checkup. Individuals who show severe hypoxemia need to be admitted in the hospital for intravenous therapy. Patients who show severe pneumonia and failure in breathing should be transferred to an intensive care unit. The rate of death in patients ailing from both AIDS and pneumocystis pneumonia is usually between ten to twenty per cent during the early stages of infection. Still, the ratio goes up with the need for exposure to air. The death rate of patients with pneumocystis pneumonia present but HIV absent is thirty to sixty per cent subject to the population at danger with patients who have cancer at a higher threat. The organism is oval, spherical with a thick-walled cyst and cup-shaped.
In conclusion, Pneumocystis pneumonia is a critical source of illness and mortality in patients having an impaired immune system. Inflammatory responses are identified by injury of the lung and respiratory problem in the host. The recommended medication for Pneumocystis pneumonia is trimethoprim sulfamethoxazole which is useful in suppressing lung inflammation among patients with severe infections.